The aim of this study was to conduct an instrument test of the Canadian questionnaire Alberta Context Tool (ACT) version Long-Term care for Swedish conditions. ACT is designed in order to measure the context in the care environment and different behaviours related to the changes in clinical practice. In total, 159 Licensed Practical Nurses (LPNs) and Registered Nurses (RNs) within municipality care of the elderly were included in the survey. The test included the instrument's reliability and face validity.The reliability test was implemented through calculation of Cronbach´s Alpha, and showed internal consistency for five of the scales of the ACT-instrument with Cronbach´s Alpha values ranging between 0,728 and 0,873. However, three dimensions got lower values (0,558 - 0,683).The analysis was carried out with content analysis and carried out for LPNs and RNs in separate groups. The majority of LPNs expressed that it was easy to respond to the questions (56%), while nine percent considered it as difficult. Eleven comments were given about questions that were perceived to be unclear, complicated or contained difficult words. In the RN group only 30 percent considered that the questions were easy to respond to. One third of the RNs considered that part of the questions were unclear, and six RNs expressed also which questions they experienced as unclear. In general, the questions in the ACT were perceived as relevant. The instrument's relevance as a tool to measure contextual factors that influence the implementation of evidence based nursing can also be considered to be determined. By modifying the content in the questionnaire in accordance with what appeared in this survey and to implement yet another test, the instrument should be considered to be relevant for use within Swedish municipality care of the elderly. ACT can be used both as a tool in the work on improvement of clinical practice and as a tool for further research about implementation of evidence based nursing.

The purpose of the research is to explore the veteran¡¦s perceptions in living Taiwan, back to settle in hometown, the status quo of long stay in mainland China, and why they gave up staying there for long term living but went back Taiwan. It is expected that the research results would be references for relevant authorities when they take measures to take care of the veteran¡¦s livelihood. The study is mainly a qualitative research with in-dept interview and literature review, while the research scope is limited only to those senior veterans in long-term care at certain nursing home of Veterans Affairs Commission, Executive Yuan in certain area who have given up long-time living in mainland China but went back to settle in Kaohsiung area, which totally are 9 persons. The research results found that (1) though the unmarried and lonely veterans have taken the army as their homes since they retreated to Taiwan and missed their hometown, they all deeply disposed to Taiwan; (2) the senior veterans went back to their hometown only for the reason as ¡§falling leaves return to roots¡¨, ¡§happily reunion with family¡¨, but the connection of family feeling was based on money; (3) when back to hometown, the livelihood of those senior veterans were mostly out of question, part of them get married and built houses, or even supported their relatives and inferiors with money; (4) the main reasons they gave up living there were the cold weather, inadequate medical care and so on. There are 3 dimensions in the research¡¦s suggestions: 1. the mental health network for veterans (including case management etc.) should be built up; 2. the business of veterans¡¦ long stay in mainland China should be forwarded (so as the mechanism positively assisting veterans in long term care to go back Taiwan should be established); 3. the practice of long-term care institution for veterans (providing the second time holistic care service and so on for the senior veterans) should be developed.

A modern democratic nation is responsible to taking care its people¡¦s basic needs. This is not only the essential reason for the existence of a nation, but also its responsibility and obligation. The right to life is an important issue in international treaties and constitutions of variable nations. People are entitled to claim care from their countries to maintain a reasonable living standard. Countries are obliged to safeguard its people¡¦s right to life through legislation, to provide basic living needs which meet human nature dignity. A nation has many obligations include the maintaining of individual health, ensuring sound environment, social relief and social insurance. Financial operation is a key issue in managing a nation. Therefore, in fulfilling the obligations, a nation must consider its financial affordability seriously so as not to deteriorate its finance for overly taking care of its people. Due to rapid aging of population and low fertility, Japan implemented Long Term Care Insurance in 2000; however, many a relative legal issue was encountered while conducting such system. For instance, for the purposes of convenience and efficiency in collecting premiums, a special levy is applied to 90% of No. 1 insurees whose age were over 65, the premiums were pre-deducted from their perpetual pensions, which may cause the qualms about trenching on the capability of people to maintain a lowest living standards and the abuse of the power of administrative decision. Eyed on financial consideration, Japanese government carried out the Law for Long Term Care Insurance, refuses its service to those whose premiums were over due, and suppresses the accessibility for the poor. The group that was supposed to be taken care of by the government is totally neglected while the middle class taking advantages from the system and waste more public fund. This is completely opposite to the objectives of the long term care system legislation. This also caused the disputes that the right to life regulated in the article 25 of Japanese Constitution is violated by administrative power. Our nation is confronted with population aging and low fertility as well lately. The total fertility rate has declined to 0.895, which is the lowest in the world. In the aging society, the long term care need of the elders and the disabled, and related heavy financial burdens are already far beyond the capacities of individuals or families and become a ¡§Social Risk.¡¨ Such a risk will need a coercive risk managing technique enforced by the nation, to organize a social insurance structure so as to share the risk and reduce individuals¡¦ burdens. Our government is engaging in planning a long term care system. The flaws of Japan¡¦s Law for Long Term Care Insurance, both in legislation and enforcement, can be valuable lessons for us. This essay discussed the legalization of the long term care system of our nation, reviewed its jurisprudence and raised integrated long term care concept. Some suggestions concerned with operation subject, insurance objects and financial plans were provided in hope with a comprehensive guideline on policy making, legislation and enforcement and system construction can be established.

Regular walking has several physical and psychological benefits for frail older people. However, many residents in long-term care facilities are too sedentary to achieve these benefits. Indoor walking appears to be a feasible way to promote active living among these residents and yet, there is little research that has been done in this regard. The researcher conducted two studies in Central Texas to explore how corridor design features influenced indoor walking behaviors among assisted living residents. In the first study, the researcher carried out six focus groups with 50 assisted living residents, discussing how they perceived the indoor corridor as "walkable." Residents reported that a walkable corridor should be safe, comfortable, and having beautiful/interesting things to see. In the second study, the researcher further examined the relationship between the built environment and walking behaviors among 326 residents from 18 facilities in a major city of Texas. The results indicated that 'perceived looped corridor' and 'number of stories' were significantly associated with residents' frequencies of indoor recreational walking. In addition, the availability and quality of sitting space around mailbox areas influenced the number of "walking to mailbox" trips. This research provides empirical evidence to develop activity-friendly facility design guidelines, and to create environmental interventions to facilitate active lifestyles among long-term care residents.

THESIS ABSTRACT For the past few years, the development of social welfare has a tendency of leading the managing concept of business administration, which emphasizes the connection between service and cost, and the requirement of efficiency. However, in spite of the increasing demand of long-term care, the nursing system has come across many difficulties. The competition from the related occupations, the increasing pressure, and the higher demand of nursing quality have seriously affected the maintenance of nursing organization, which also have obliged the manager of nursing organization to consider the possibility of cooperation of the same line. The intention of Strategic Alliance between the aged long-term care organization and some medical organizations has been promoted. In the near future, the manager of medical and long-term care enterprises will be up against the challenges and competitions from these organizations. And they are forced to unite and share their resources by Strategic Alliance. The manager must realize the changes inside and outside of their organizations. And it is the most important to adopt the prompt policy, management and control of their resources. Through this research, I hope there will be better understanding for the main managers on their long-term care services and evaluation of satisfaction. Also, I wish to study the elements that influence the quality of service. Therefore, the resources of long-term care might be efficiently used, and the quality will be improved as well. In experimental research, I make use of contrast of Strategic Alliance which influences the quality of service by analysis of 84 questionnaires investigation reports from Won-An and Won-Tai Nursing Centers. The experiments are independent and circuitous. . The result of this study indicates that Strategic-Alliance makes influence on either service quality or customers¡¦ satisfaction. Customers gave Won-An Nursing Center a higher appreciation because which practice Strategic-Alliance. At the end, this study offers concrete suggestions for management. Hopefully this will provide the government authorities a consultation of policy as well as a new direction of the long-term care organizations.

Taiwan's population aging rapidly, making many current long-term care institutions, in their business model is extremely different from the past .The purpose of this study is to investigate the market supply and demand for long-term care institutions and the current operating status of the long-term care institutions in Kaohsiung area, thereby identifying the key successful factor of the institutions operating surface. This study adopts case study research of descriptive studies, by the way of in-depth interview to collect information on cases, and adopts Prof. Cher-Min Fong¡¦s ¡]National Sun Yat-sen University¡^the seven dimensions of the business model used, to analysis the competitive advantage of enterprises, as the main analytical tools, including the "product line strategy," "work processes strategy," and " Channel strategy " and "market segmentation strategy," " Services strategy," "strategy focused on the value of activities" and "Technology Strategy"; In addition to Michael Porter¡¦s "five forces anaysis model" and the external environmental factors as a supplementary analysis tools. Through six cases of the in-depth interview, this thesis research found that: The current domestic long-term care market, supply far exceeds the actual demand of about twice.The operating of long-term care institutions of conservation type, failed to actively cooperate with the government planning of aging in place, community service goals, adjusted operating strategies, result in more limited operation. In addition to five forces analysis found that the current operating environment of the existing institutions is adverse, and inter-industry bargain with serious competition, lower quality of care even more serious situation, but also the moral crisis will inevitably trigger controversy. Institutional trading competition, the lack of mutual contacts and exchanges, and their competitiveness also depends on whether the operator has the determination to develop long-term investment. The interview results, the next most important business strategy followed by "expansion of target markets and positioning," "increase services, outreach services," and "innovative services, commodities" and "improving the organizational structure and management system." The future as more competitors access will be serious competition and in the circumstances of difficult to reduce costs, strengthening marketing capabilities, to pursue the differences and decentralization strategy for the industry.

Thesis (M.S.W.) - Carleton University, 2009. / Includes bibliographical references (p.99-104). Also available in electronic format on the Internet.

Adjustment to assisted living does not always proceed smoothly, making it imperative to identify predictors of transition difficulties, such as personality factors. The sample for this cross sectional study included 64 older adults from ten assisted living communities in the southeast. The primarily white, well-educated, and female sample had an average age of 86 years. Correlation was used to examine relationships between individual personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and adjustment. Factor analysis determined both the predictor variables and outcome variables for inclusion in regression analyses. The regression analyses examined the predictive capacity of personality relative to other associated indicators on adjustment. Hermeneutic phenomenological analysis of responses to an open-ended question regarding subjective adjustment was also conducted. Regression analysis found that participation in community activities, satisfaction with food quality, and ability to set one’s daily schedule were important predictors of adjustment. Above and beyond these predictors, neuroticism was found to predict adjustment, indicating that personality does play a role in determining adjustment to assisted living. The responses to the open ended question echoed these results and revealed additional salient issues and barriers related to resident perceptions of adjustment. Implications for practice and future research are discussed.

Our current LTC system is burdensome to state and federal governments, to family members, and to individuals’ pocket books; it is not expected to endure the weight of the baby boom generation. Total national spending for long-term care in 2005 was $207 billion and is only expected to rise. This study examined the LTC planning behavior of individuals of baby boom birth years (1946 to 1964), focusing on the influence of individuals’ views about whose responsibility is the provision of LTC on planning behavior. Specifically, the study has three aims: to 1) to describe the LTC planning behavior among baby boom aged adults; 2) examine baby-boom aged adults’ views on whose responsibility is the planning/provision/cost of LTC (location of responsibility); and 3) examine the influence of potential predictors of individuals’ LTC planning with specific focus on the influence of location of responsibility (LOR). Data was collected between May and August of 2009 using a mixed modes self-administered 80-item original survey via the internet and regular mail (study sample = 1,066; 1,166 responding; response rate 58%). The study population consists of benefit-eligible Black, Hispanic/Latino, and Non-Hispanic White faculty/staff born in or between the years of 1946 and 1964 from a large southwestern university. This study found overall low levels of LTC planning; however, with regard to LTCI purchase, the participation rate is good relative to the national coverage rate. The study informs us that baby-boom aged individuals as a whole believe themselves (individuals) to have a high level of responsibility for their own potential LTC needs, but also that responsibility lies with the government, employers, and adult children as well. Consistent with hypotheses, LTC awareness/avoidance predicted a higher level of extent of planning (gathering, deciding, and concretizing); worthwhileness and self-efficacy predicted LTCI purchase; and awareness, subjective norm, worthwhileness, and self-efficacy predicted LTC specific savings. Additionally, individual responsibility (negatively), female (positively), income (positively), experience (self and other; positively), LTC knowledge (positively), and Hispanic (negatively) all predicted extent of planning. Employer responsibility (positively), faculty (negatively), marital status (married; negatively), Black (positively), and medical diagnoses all predicted LTCI purchase. And, employer responsibility (positively), government responsibility (negatively), income (positively), experience-other (positively), and knowledge (positively) all predicted LTC-specific savings. Implications for practitioners, employers, program planners, and policy-makers are presented. / text

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